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Our Sample Qbank: USMLE Setp 2, 3

Endo #121

Obgyn #26

A 22-year-old female was taken to the emergency room in coma. Her parents noticed that she had for the past 1 month polydipsia, polyuria, and rapid weight loss. These symptoms had worsened in the last week. She had not been taking any medications and the clinical history was otherwise unremarkable. On examination, breathing was deep and rapid (Kussmaul respiration), pulse rate was 104 beats per minute, and blood pressure 110/70 mmHg; she also revealed a mildly dehydrated patient. She was drowsy and confused. Rapid hematology and biochemical tests showed

Hematocrit 46%

Hemoglobin 13 g/dl (140 g/L)

White blood cell count 11,000/ μl

Glucose 520 mg/dl (28.9 mmol/L)

Urea 50 mg/dl (8.5 mmol/L)

Creatinine 0.8 mg/dl (70.7 μmol/L)

Na+ 148 mEq/L

K+ 4.6 mEq/L

PO4 3-2.0 mEq/L (0.64 mmol/L)

Cl− 112 mmol/L

Arterial pH was 7.0

PO 2 98 mmHg

PCO 2 25 mmHg

HCO 3−12 mEq/L

O 2 sat 98%.

What’s the diagnosis?

A. Cerebral edema

B. Rhabdomyolysis

C. Acute pancreatitis

D. Sepsis

E. Acute abdomen

F. Diabetic Ketoacidosis

G. Alcoholic ketoacidosis

A 28-year-old woman comes to the clinic at 29 weeks gestation complaining of headaches and abdominal pain. She states that these symptoms began 5 days ago and have been worsening. The patient's vitals are notable for a blood pressure of 175/95 mmHg. On physical exam pain is elicited upon palpation of all 4 quadrants, in particular the right upper quadrant. A urine dipstick demonstrates 3+ protein. The patient is admitted to the hospital and started on IV magnesium sulphate and labetalol. Five hours after this treatment has begun she has a seizure.

What is the next best line of mangement?

A. Start IV lisinopril

B. Observe expectantly and deliver only if the patient shows signs of seizure

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